John Goodman on Justice

A few days ago, I posted on a John Goodman post in which he asserted that he knows of no theory of justice that would imply that the Affordable Care Act, aka ObamaCare, is a good idea. There followed a lively discussion on Goodman's site. One of the discussants who often chimes in was Princeton University health economist Uwe Reinhardt. Professor Reinhardt wrote:

In our capacity of economist, we have nothing to say about the morality of public policy.

As citizens, of course, we can comment on morality as it derives from whatever theory of justice we favor.

There is no overarching theory of justice. Here as elsewhere, it is a matter of consumer choice.

I agree with Uwe Reinhardt's statements. But notice that he avoided the issue that John Goodman raised. John was granting that there's no one theory of justice that everyone agrees with, which is what I assume Uwe meant by "no overarching theory of justice." But John was going beyond that and challenging people to give a theory of justice that would imply the particular elements of ObamaCare, some of which he identified in his post. So far, neither Reinhardt or any of the other people who have commented on John's post have tried to do it. Instead, they name specific things that they find unjust pre-ObamaCare and simply assume that ObamaCare fixes those things and doesn't do any things that they would think are unjust. But they're just assuming. They aren't examining the details and they aren't making an argument.

Comments and Sharing

I have to question any notion of justice that prefers that government subsidize rich people rather than poor people.

That goes both for Medicare's subsidizing the health care of millionaires on Medicare with taxes taken from the first dollar of the working poor and for ObamaCare's subsidizing the health care of those above the poverty line in the US when there are billions of authentically poor people in the world that it doesn't subsidize.

If you are going to include the world, then there are few people below the poverty line in the U.S. that would qualify as authentically poor. An apartment, tv, refrigerator, maybe an old car doesn't make you poor in many parts of the world. Of course, that doesn't mean it is wise to subsidize the rich either.

One of the unpleasant things about discussing policy, even with people who claim to know much about the policy, is people twist the policy argument into a morality argument around whatever the policy is generally supposed to do, whether or not it is effective.

Very rarely will people stick to questions and debates around the actual policy implementation.

Indeed, the conclusion once you bring arguments based on justice into the picture is pretty much inescapable: either no subsidy at all or no subsidy for any but the starving. For there is always a starving person who is more "deserving" of the subsidy than someone who is not starving.

And consider that those who would argue that there is some theory that justifies subsidizing the recipients of ObamaCare's over subsidizing billions of authentically poor people do not even recognize the right of those people to live or work subsidy-free in the US.

John just asserts that the ACA will not work. If you start with that assumption, it makes his arguments work, sort of. If you believe the large amount of evidence showing that it will increase coverage, his case is shot down.

I've always thought the ACA would increase coverage. And that's a big problem. The act will probably insure an additional 32 million people and it will force almost everyone else to have more generous insurance than they have today. Read: huge increase in the damand for care. But there are no provisions to increase supply.

So get ready for a big rationing problem. And that doesn't bode well for anyone in a plan that pays below market fees to providers.(Seniors and the disabled on Medicare, poor people on Medicaid and probably people getting subsidized insurance in the new health insurance exchanges.)

Any way, my piece was not about how all this would pan out, but rather whether anyone could find any moral principle that could justify this mess.

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